A detachable vertical cutter for insertion into a cylinder or tube is formed as a single unitary structure. The single blade has a pair of tool attachment end portions and a cutting blade extending in a loop between the attachment ends. The cutting blade is inclined vertically relative to a longitudinal axis of a cylinder or tube into which the attachment ends can slide into. The cutting blade has a cutting edge, a portion of which when extended free of the cylinder or tube will extend a distance greater than the tube outside diameter. The cutting edge when pushed inwardly and pulled outwardly between adjacent vertebrae scrapes and cuts disc material. When retracted the cutting blade deflects into the cylinder or tube for insertion or extraction into or from the disc space.
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1. A method of preparing a void space between adjacent vertebrae of a patient for placing a fusion implant device comprising the steps of:
locating a position on the patient to make an incision;
cutting tissue at the location by making the incision;
placing an outer guide tube having an inside diameter into the incision;
inserting a cutting tool with a retracted cutting blade inside a tool tube sized to pass through the inside diameter of the guide tube while having the cutter retracted internally;
extending the tool tube past the guide tube directed toward a disc space;
protracting the cutting blade free of the tool tube while orienting the cutting blade vertically up or down relative to a longitudinal axis of the tool tube and wherein the protracted cutting blade has a loop shape with an inclined cutting edge extending several mm above or below the tube, wherein the cutting blade is inclined vertically relative to a longitudinal axis of the tool tube into which an attachment end of the cutting blade slides into, the cutting blade having a cutting edge, a portion of which when extended free of the tool tube extends a distance above the tool tube outside diameter, the cutting edge cuts linearly relative to the longitudinal axis as the cutting blade is moved inwardly and outwardly and when positioned between adjacent vertebrae is configured to cut disc material by the cutting tool being pushed inwardly and pulled outwardly relative to the disc as the cutting edge of the cutting blade scrapes and cuts the disc material parallel to the longitudinal axis of the tool tube, and the cutting blade when retracted deflects into the tool tube for insertion or extraction into or from the disc space;
cutting away disc tissue by having the cutting tool directed at one vertebra to form a void space by pushing and pulling the cutting tool in an axial direction relative to the disc;
scraping the cutting blade along an exposed bone surface of one of the adjacent vertebrae thereby removing an outer layer or layers of bone tissue and laterally inclining the guide tool left or right slightly to widen void space;
turning the tool 180 degrees to repeat the steps of cutting away disc tissue and scraping bone layers of the other vertebrae of the adjacent vertebrae to complete the void space; and
retracting the cutting blade within the tool tube and withdrawing the cutting tool from the incision.
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This application is a division of U.S. application Ser. No. 14/448,490 entitled “Vertical Cutter And Method Of Use” filed Jul. 31, 2014.
The present invention relates to an improved tissue and bone surface scraping and cutting device for preparation of the spinal disc space for implantation of a fusion implant device.
In open spinal vertebrae surgical procedures, the surgeon makes an incision through the skin and muscle tissue and exposes the area to be worked on using retractors separating the tissue above the adjacent vertebral bodies and the interposed disc. Using cutting devices such as a spoon curette or rongeur, the surgeon cuts away the bone and disc material and prepares a space for a spinal fusion device to be placed.
In minimal invasive surgery, the large incision is not used and in its place a smaller cut is made just large enough to position a small hollow tube or cylinder into the disc space between the two vertebrae to be fused together. It is through this tube that the cutting tools must pass to remove the disc material and prepare the space for a fusion implant device. The vast majority of these cutting devices operate by rotational cutting of the tissue to be removed. This allows for a circular cross sectional removal of the disc, but requires rather difficult angulation to flatten or widen the space being prepared. A secondary issue is to flex into a tube fitting compressed size; the blades typically have two or more separate cutting blades as in U.S. Pat. No. 5,709,697. This enables the blades to deflect into a tube, but uses a small pointy tip prone to break when in use leaving metal fragments.
Very importantly, these rotational devices are limited in vertical reach that can be achieved. In some small patients, this represents little trouble, but in larger boned patients, the vertical space required for the implant can exceed the capacity of the device.
The present invention as described hereinafter avoids these issues in a new and improved way to provide the surgeon a much simpler and efficient way to prepare the disc space for implantation.
A vertical cutter for insertion into a cylinder or tube is formed as a single unitary structure. The single blade has a pair of tool attachment end portions and a cutting blade extending in a loop between the attachment ends. The cutting blade is inclined vertically relative to a longitudinal axis of a cylinder or tube into which the attachment ends can slide into. The cutting blade has a cutting edge, a portion of which when extended free of the cylinder or tube will extend a distance greater than the tube outside diameter. The cutting edge when pushed inwardly and pulled outwardly between adjacent vertebrae scrapes and cuts disc material. When retracted the cutting blade deflects into the cylinder or tube for insertion or extraction into or from the disc space.
The blade is cut from a flat sheet of shaped memory alloy and heat set to form the loop. The sheet has a nominal thickness of 0.5 mm or greater. The cutting blade has a nominal width of 2.0 mm or greater. The cutting edges are the inclined outer edges at the intersection of the thickness and the width. The cutting blade has curved opposing sides spanning a nominal maximum width between opposite sides a distance of 10.5 mm or greater.
The cutting blade when withdrawn into the tube or cylinder bends or deflects the curved opposing sides of the cutting blade to fit the inside diameter. This also lowers or bends the flattened end vertical inclination to slide into the tube or cylinder. The cutting blade has flattened distal end portion between the two curved sides along a vertical cutting peak extending at least 3 mm. The cutting blade is configured to fit into a tube or cylinder having a nominal outside diameter of 8 mm. The vertical inclination of the cutting blade extends at least 2 mm or greater above the outside diameter of the tube when the cutting blade is extended free of the tube.
A vertical cutting tool has a shaft, a tube or cylinder and a single cutting blade. The shaft has the cutting blade attached at one end and is externally threaded at an opposite end. This hollow tube or cylinder is for receiving the shaft internally. A rotatable knot is affixed to the hollow tube and is rotatable independent of the tube or cylinder. The knob has internal threads to engage the threads of the shaft. This rotatable knob adjusts the protruding amount to deploy the cutting blade. The single vertical cutter has a pair of tool attachment end portions and a cutting blade extending in a loop between the attachment ends. The cutting blade is inclined vertically relative to a longitudinal axis of a cylinder or tube into which the attachment ends slide into. The cutting blade has a cutting edge, a portion of which when extended free of the cylinder or tube extends a distance above the tube outside diameter. The cutting edge when pushed inwardly and pulled outwardly scrapes and cuts the disc material, and when retracted deflects into the cylinder or tube for insertion or extraction into or from the disc space. The vertical cutting tool further comprises a push pull knob fixed to the rotatable knob to cut inwardly and outwardly parallel to the tube or cylinder longitudinal axis.
The vertical cutter of the present invention allows for the method of preparing a void space between adjacent vertebrae for placing a fusion implant device comprises the steps of locating a position on the patient to make an incision; cutting the tissue at the location by making a small incision; placing an outer guide tube having an inside diameter into the incision; inserting a cutting tool with a retracted cutting blade inside a tube sized to pass through the inside diameter of the guide tube while having the cutter stowed internally; extending the tool tube past the guide tube directed toward a disc space; protracting the cutting blade free of the tool tube while orienting the cutting blade vertically up or down relative to a longitudinal axis of the tool tube and wherein the protracted cutting blade has a loop shape with an inclined cutting edge extending several mm above or below the tube; cutting away disc tissue directed at one vertebrae to form a void space by pushing and pulling the tool in an axial direction; scraping the cutting blade along the exposed bone surfaces of the adjacent vertebrae thereby removing an outer layer or layers of bone tissue and laterally inclining the guide tool left or right slightly to widen the void space; turning the tool 180 degrees to repeat the steps of cutting away disc tissue and scraping bone layers of the other vertebra to complete the void space; and retracting the cutting blade and withdrawing the cutting tool.
The method can further include a step of retracting the cutting blade prior to turning the tool 180 degrees. The method wherein the cutting edge has a flat portion extending at least 3 mm above the tool tube and the tool tube has an outside diameter of 8 mm. The method wherein the cutting edge can cut disc tissue and vertebral bone to form a total maximum void space height over 14 mm, 7 mm upwardly and 7 mm downwardly between two adjacent vertebrae. The method wherein the cutting blade can be partially retracted to cut at lower heights.
As used herein and in the claims:
A “curette” is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge.
A “rongeur” is a strongly constructed instrument with a sharp-edged, scoop-shaped tip, used for gouging out bone.
The invention will be described by way of example and with reference to the accompanying drawings in which:
With reference to
With reference to
With particular reference to the detachable vertical cutter 10, as illustrated in
As illustrated in
With reference to
With reference to
This cutting tool 100, as illustrated, with the vertical cutter 10 provides a unique way of removing disc material and preparing two adjacent vertebrae for receiving any spinal fusion implant device. The surgeon will simply locate a position on the patient's back to make an end incision. The surgeon cuts the tissue at the location by making a small incision and inserting a solid tapered dilator to allow insertion of an outer guide tube 200 that will hold the tool tube 102 portion of the tool 100. This outer tube 200 is illustrated in
In order to cut the opposite adjacent vertebral body disc material, the surgeon can either retract if so desired or simply rotate the tool 100 such that it lines up with a vertical downward extension if he has previously cut in a vertical upward position. By extending the tool 100 in a downward direction he can now cut the lower vertebral body disc tissue above it and prepare that space by repeating the procedure in a push pull manner completing all the cutting without any requirement for rotational cutting of disc material. In this way, a chamber or void space that is basically rectilinear and ideally suited for receiving a spinal implant device is formed. Once all the material has been cut away and the end plates have been scraped, the device can be retracted and pulled out of the guide tube 200 such that an implant device can be positioned through the guide tube 200 to complete the procedure. While various dimensions have been mentioned for the exemplary embodiment, these dimensions can be varied using the concepts taught herein and will still be within the scope of the present invention.
Variations in the present invention are possible in light of the description of it provided herein. While certain representative embodiments and details have been shown for the purpose of illustrating the subject invention, it will be apparent to those skilled in this art that various changes and modifications can be made therein without departing from the scope of the subject invention. It is, therefore, to be understood that changes can be made in the particular embodiments described, which will be within the full intended scope of the invention as defined by the following appended claims.
Tally, William Carlton, Barra, Kenneth Richard
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